Women's Health

Menstrual Pain

Menstrual cramps are sharp pains in a woman's lower abdomen that occur when her menstrual period begins and may continue for two to three days. Symptoms can range in severity from a mild annoyance to severe pain that interferes with normal activities.

Menstrual cramps are the leading cause of absenteeism in women younger than 30 years. Although over half of women who have menstrual periods experience some discomfort, 10% are temporarily disabled by symptoms.

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The following circumstances may make a woman more likely to experience menstrual cramps:

• She started her first period at an early age (younger than 11 years).
• Her menstrual periods last five days or longer.
• She is overweight or obese.
• She smokes cigarettes or uses alcohol.
• She has never been pregnant.

Causes of Menstrual Pain

Prostaglandins are chemicals a woman's body produces that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus makes these chemicals. Prostaglandins stimulate the uterine muscles to contract. Women who have high levels of prostaglandin may experience more intense contractions of their uterus and more pain. Prostaglandins may also be responsible for vomiting, diarrhea, and headaches that accompany painful periods.

Other menstrual-type pain can be caused by conditions of the reproductive tract, such as the following:

• Endometriosis -- Uterine tissue that appears outside the uterus
• Fibroids and adenomyosis -- Non-cancerous (benign) growths in the uterus
• Infections in the reproductive organs
• Abnormal pregnancy, such as an ectopic pregnancy (pregnancy in the tubes, outside the uterus)
• IUD (intra-uterine device) used for birth control
• Ovarian cyst
• Narrow cervix

If a woman has had menstrual pain ever since her periods started, the condition is classified as primary dysmenorrhea. If some physical condition such as pelvic inflammatory disease or endometriosis is causing the menstrual pain, this is called secondary dysmenorrhea. Once the medical condition is treated, the menstrual pain usually goes away.

Symptoms of Menstrual Pain

In addition to cramps in the lower abdomen, a woman may also experience some of these symptoms with menstrual cramps:

• Lower back pain
• Leg pain, radiating down the legs
• Nausea
• Vomiting
• Diarrhea
• Headaches
• Irritability
• Weakness
• Fainting spells (in extreme cases)

When to Seek Medical Care

Most women have significant improvement with home care. However, a woman should call her health care provider in these situations:

• Menstrual cramps continue to be painful for longer than usual.
• The pain is suddenly worse or different from what she may have experienced before.
• Bleeding is excessive, requiring more than one pad or tampon per hour.
• Signs of infection, such as fever, chills, and body aches, are present at the time of the period.
• Menstrual cramps began in a woman older than 25 years.
• The woman suspects she may be pregnant and any of these symptoms occur.

The woman's doctor can help her manage most symptoms. However, she should go to a hospital's emergency department if any of the following problems occur:

• She faints.
• She experiences repeated dizziness when standing up.
• A sudden, intense pelvic pain causes her to double over.
• Tissue is passed in the menstrual flow. Tissue often appears silvery or grayish.
• She thinks she might be pregnant and has menstrual-type pain.